LARYNGEAL PERICHONDRITIS. 49 



solution, is of questionable service. When the ice fails, we should en- 

 deavor to effect scarification of the swelling, either by means of the 

 finger-nail or with a bistouri, guarded with adhesive plaster almost to the 

 point. If we should be unsuccessful, or should the scarification be with- 

 out effect, or should the symptoms of carbonic-acid poisoning arise, the 

 pulse growing small and irregular, and the senses benumbed, we must 

 proceed forthwith to tracheotomy and insert a canula until the danger is 

 past. In cases like this, the operation, as a whole, is more successful 

 than in croup, and life has been preserved for months in cases where 

 oedema glottidis has occurred in tuberculosis of the larynx. 



CHAPTER IX. 



LARYNGEAL PERICHONDRITIS. 



ETIOLOGY. The perichondrium or fibrous tissue immediately in con- 

 tact with the cartilages is tolerably firm and resisting in texture, so that 

 it long withstands any ulcerative process which advances from the mucous 

 membranes. When finally perforated, the cartilage is laid bare, and its 

 connection with its nutrient vessels is suspended. The portion thus de- 

 nuded, and deprived of nourishment, sloughs off, and is discharged. 

 We have already stated that these necrosed bits of cartilage generally 

 show traces of ossification, which is one of the early effects of ulcera- 

 tion of the mucous membranes of the larynx. 



By perichondritis laryngea, however, we do not generally mean in- 

 flammation and ulceration of portions of the perichondrium, penetrating 

 from without inward, but refer rather to an affection in which an ex- 

 udation forms between the cartilage and the perichondrium, and by 

 which the latter, from its density and impenetrability, undergoes very 

 extensive separation. Necrosis of the cartilage is the natural result of 

 so great a detachment from its nutrient vessels. 



Its exciting causes are sometimes ulceration of the laryngeal mucous 

 membrane above mentioned, in which, however, the perichondrium, in- 

 stead of suffering penetration from without, becomes the seat of suppu- 

 rative inflammation, which causes an effusion between perichondrium 

 and cartilage. 



In other cases the malady arises independently, or at least, without 

 previous inflammation of the mucous membrane, and chiefly in persons 

 with constitutions broken down by syphilis, mercury, or by the infection 

 of typhus, septichaemia, and the like ; and sometimes even in subjects 

 who apparently are robust. Of course, in the latter instance, " catching 

 cold " is assigned as the cause ; the inflammation is called a rheumatic 

 inflammation, and the destruction of the larynx which follows is called 

 a rheumatic laryngeal phthisis. 

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